Apo-Prednisone , Deltasone, Meticorten, Orasone, Panasol, Prednicen-M, Sterapred, Winpred
Classifications: adrenal corticosteroid; glucocorticoid; Therapeutic: corticosteroid; glucocorticoid
Pregnancy Category: C
1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg tablets; 5 mg/5 mL, 5 mg/mL solution
Immediate-acting synthetic analog of hydrocortisone. Effect depends on biotransformation to prednisolone, a conversion that
may be impaired in patient with liver dysfunction. Less mineralocorticoid activity than hydrocortisone, but sodium retention
and potassium depletion can occur.
Has antiinflammatory properties.
May be used as a single agent or conjunctively with antineoplastics in cancer therapy; also used in treatment of myasthenia
gravis and inflammatory conditions and as an immunosuppressant.
Systemic fungal infections and known hypersensitivity; cataracts; pregnancy (category C).
Patients with infections; nonspecific ulcerative colitis; diverticulitis; active or latent peptic ulcer; renal insufficiency;
coagulopathy; psychosis; seizure disorders; thromboembolic disease; hypertension; osteoporosis; myasthenia gravis.
Route & Dosage
Adult: PO 560 mg/d in single or divided doses
Child: PO 0.10.15 mg/kg/d in single or divided doses
Child: PO <1 y, 12 mg/kg/d x 35 d or 10 mg q12h; 14 y, 20 mg q12h; 513 y, 30 mg q12h; >13 y, 40 mg q12h x 35 d
Alternate-Day Therapy (ADT) for Patient on Long-Term Therapy
- Crush tablet and give with fluid of patient's choice if unable to swallow whole.
- Give at mealtimes or with a snack to reduce gastric irritation.
- Dose adjustment may be required if patient is subjected to severe stress (serious infection, surgery, or injury) or if a
remission or disease exacerbation occurs.
- Do not abruptly stop drug. Reduce dose gradually by scheduled decrements (various regimens) to prevent withdrawal symptoms
and permit adrenals to recover from drug-induced partial atrophy.
- With ADT, the 48-h requirement for steroids is administered as a single dose every other morning.
- Be aware that ADT minimizes adverse effects associated with long-term treatment while maintaining the desired therapeutic
Adverse Effects (≥1%)CNS:
Euphoria, headache, insomnia
, confusion, psychosis. CV:
CHF, edema. GI:
Nausea, vomiting, peptic ulcer
Muscle weakness, delayed wound healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures. Endocrine:
Cushingoid features, growth suppression in children, carbohydrate intolerance, hyperglycemia. Special Senses:
, phenytoin, rifampin
increase steroid metabolismincreased doses of prednisone may be needed; amphotericin B, diuretics
loss; ambenonium, neostigmine, pyridostigmine
may cause severe muscle weakness in patients with myasthenia gravis; may inhibit antibody response to vaccines
Readily from GI tract. Peak:
12 h. Duration:
11.5 d. Distribution:
Crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
Hypothalamus-pituitary axis suppression: 2436 h; in urine. Half-Life:
Assessment & Drug Effects
- Establish baseline and continuing data regarding BP, I&O ratio and pattern, weight, fasting blood glucose level, and sleep
pattern. Start flow chart as reference for planning individualized pharmacotherapeutic patient care.
- Check and record BP during dose stabilization period at least 2 times daily. Report an ascending pattern.
- Monitor patient for evidence of HPA axis suppression during long-term therapy by determining plasma cortisol levels at weekly
- Lab tests: Obtain fasting blood glucose, serum electrolytes, and routine laboratory studies at regular intervals during long-term
- Be aware that older adult patients and patients with low serum albumin are especially susceptible to adverse effects because
of excess circulating free glucocorticoids.
- Be alert to signs of hypocalcemia (see Appendix F). Patients with hypocalcemia have increased requirements for pyridoxine
(vitamin B6), vitamins C and D, and folates.
- Be alert to possibility of masked infection and delayed healing (antiinflammatory and immunosuppressive actions). Prednisone
suppresses early classic signs of inflammation. When patient is on an extended therapy regimen, incidence of oral Candida infection is high. Inspect mouth daily for symptoms: white patches, black furry tongue, painful membranes and tongue.
- Monitor bone density. Compression and spontaneous fractures of long bones and vertebrae present hazards, particularly in
long-term corticosteroid treatment of rheumatoid arthritis or diabetes, in immobilized patients, and older adults.
- Be aware of previous history of psychotic tendencies. Watch for changes in mood and behavior, emotional stability, sleep
pattern, or psychomotor activity, especially with long-term therapy, that may signal onset of recurrence. Report symptoms
- If a patient is receiving aspirin concomitantly with a corticosteroid, salicylism may be induced when the corticosteroid
dosage is decreased or discontinued.
- Be aware that long-term corticosteroid therapy is ordinarily not interrupted when patient undergoes major surgery, but dosage
may be increased.
- Monitor for withdrawal syndrome (e.g., myalgia, fever, arthralgia, malaise) and hypocorticism (e.g., anorexia, vomiting,
nausea, fatigue, dizziness, hypotension, hypoglycemia, myalgia, arthralgia) with abrupt discontinuation of corticosteroids
after long-term therapy.
Patient & Family Education
- Take drug as prescribed and do not alter dosing regimen or stop medication without consulting physician.
- Be aware that a slight weight gain with improved appetite is expected, but after dosage is stabilized, a sudden slow but
steady weight increase [2 kg (5 lb) per wk] should be reported to physician.
- Avoid or minimize alcohol and caffeine may contribute to steroid-ulcer development in long-term therapy.
- Report symptoms of GI distress to physician and do not self-medicate to find relief.
- Do not use aspirin or other OTC drugs unless they are prescribed specifically by the physician.
- Report slow healing, any vague feeling of being sick, or return of pretreatment symptoms.
- Be fastidious about personal hygiene; give special attention to foot care, and be particularly cautious about bruising or
abrading the skin.
- Report persistent backache or chest pain (possible symptoms of vertebral or rib fracture) that may occur with long-term therapy.
- Tell dentist or new physician about prednisone therapy.
- Carry medical information at all times. It needs to indicate medical diagnosis, medication(s), physician's name(s), address(es),
and telephone number(s).